What is the treatment for scalp contact dermatitis?

Treatment of Scalp Contact Dermatitis

The most effective treatment for scalp contact dermatitis is identifying and completely avoiding the causative allergen, combined with topical corticosteroids to control inflammation and moisturizers to repair the skin barrier. 1

Immediate Management

Apply mid- to high-potency topical corticosteroids as first-line treatment for acute scalp contact dermatitis. 1, 2 Hydrocortisone can be applied to the affected scalp area 3-4 times daily for symptomatic relief. 3 For more severe inflammation, escalate to higher potency agents such as triamcinolone 0.1% or clobetasol 0.05%. 4

• Topical corticosteroids provide rapid relief within 12-24 hours and remain the cornerstone of acute treatment. 1, 4
• Apply corticosteroids directly to affected areas of the scalp, avoiding prolonged continuous use beyond 2-4 weeks to prevent skin atrophy. 5
• For extensive scalp involvement (>20% of scalp surface), consider systemic corticosteroids with a 2-3 week taper to prevent rebound dermatitis. 4

Allergen Identification and Avoidance

Refer for patch testing if dermatitis persists despite initial treatment or if the causative allergen is unknown. 1, 4 This is the definitive diagnostic step and guides complete allergen avoidance, which offers the best chance for resolution. 1

• The most common scalp contact allergens are nickel (23.8%), cobalt (21.0%), balsam of Peru (18.2%), fragrance mix (14.4%), and propylene glycol (8.8%). 6
• Common sources include hair clasps, pins, brushes (metals), shampoos, conditioners, hair gels (preservatives and fragrances), and topical medications (propylene glycol). 6
• Replace all hair care products with fragrance-free, allergen-free alternatives once specific allergens are identified. 1, 2
• Avoid patch testing within 2 days of applying potent topical steroids to the scalp, as this causes false negatives. 1

Supportive Care and Barrier Repair

Substitute all soaps and shampoos with gentle, soap-free cleansers and apply moisturizers liberally to restore skin barrier function. 1

• Use moisturizers packaged in tubes rather than jars to prevent contamination. 1
• Apply moisturizers immediately after washing to damp scalp using the "soak and smear" technique when feasible. 1
• Keratolytic agents can be used first if significant scaling is present before initiating anti-inflammatory treatment. 5

Second-Line and Refractory Cases

For steroid-resistant or chronic scalp contact dermatitis, consider topical tacrolimus 0.1% or refer for systemic therapies. 1

• Topical tacrolimus is effective for contact dermatitis and avoids risks of corticosteroid allergy and skin atrophy. 1
• Phototherapy (PUVA), azathioprine, or ciclosporin are established second-line treatments for chronic refractory cases. 1
• Very high potency topical corticosteroids (clobetasol 0.05%) achieve clear or almost clear skin in 67.2% of patients with severe dermatitis over 2 weeks. 1

Critical Pitfalls to Avoid

• Do not use dish detergent, disinfectant wipes, or products containing topical antibiotics on the scalp without indication. 1
• Avoid very hot water when washing hair, as this aggravates dermatitis. 1
• Do not over-rely on barrier creams alone, as they provide questionable protection and may create false security. 1
• Prognosis for persistent contact dermatitis is poor: only 25% achieve complete healing, 50% have intermittent symptoms, and 25% have permanent symptoms despite treatment. 1 Early identification and complete allergen avoidance are essential.

Special Considerations

• For occupational scalp contact dermatitis, workplace assessment may be necessary to identify all potential hazards. 1
• Patients with suspected allergic contact dermatitis should be patch tested to at least an extended standard series of allergens. 1
• If using systemic immunosuppressants during patch testing is unavoidable, keep prednisolone ≤10 mg daily to avoid false negatives. 1